Stressed-Out Girls:
Helping Them Thrive in the Age of Pressure

Excerpt: Chapter 1
Rising Nervous Energy: The Toll of Hidden Stress

By the time they enter middle school, many girls are staggering under the pressure of more than just weighty backpacks. They also face jam-packed schedules, hours of homework, heightened expectations, demanding social lives, and far too little sleep. For this generation of girls, the process of maturing into successful young women has become too intensely charged. 

A hundred years ago, the famous educator Charlotte Perkins Gilman wrote that, “The progressive education of a child should be, as far as possible, unconscious. From his first eager interest in almost everything, up along the gradually narrowing lines of personal specialization, each child should be led with the least possible waste of time and nervous energy.”

Yet, as I speak with groups of parents around the country, attend school events in my own community, and collaborate with colleagues, I often see that families intent upon raising accomplished children are doing exactly the opposite—and as a result find themselves in perpetual states of nervous energy. At PTA meetings, athletic events, and even on grocery lines, I hear mothers and fathers worrying about their daughters’ grades in school, status with friends, progress in extracurricular activities, and chances of getting into a first-rate college. Driving much of these parents’ preoccupations are understandable fears that (a) their girls may not be doing well enough, and (b) there is something else they should be doing to help them succeed.

Adolescent girls express these same concerns. It does not matter whether I am speaking with middle school or high school students, whether they come from urban areas or privileged suburban neighborhoods, or whether I am meeting with teens in focus groups or consulting privately with them in my office. Almost without exception they tell me that they feel stressed by pressures to excel.

Although most look forward to seeing their friends in school and many enjoy a particular teacher or subject, teen girls universally dread seemingly insurmountable piles of homework and never-ending tests. They worry about completing their assignments well enough to maintain their grades—and also finishing them fast enough to keep up with their friendships and hobbies, practice their musical instruments, play sports, participate in school clubs, and look good.

And yet, despite feeling “totally stressed-out,” “overwhelmed,” and “completely exhausted,” many girls today think even doing all this is not enough. They believe they should also be doing everything perfectly. Responding to one of many harmful messages of this culture, they equate being successful with being extraordinary. These teens think that besides acing every subject, they must also star in their school plays, shine in  music, excel athletically, be popular, and win awards. Like many parents, these teen girls consider weakness in any area unacceptable. But such goals are unrealistic, if not impossible, to achieve.

Emily, my friend’s delightful, spunky 12-year-old daughter, puts it this way: “I feel like I have to have great grades, be in good shape, eat right, do lots of activities, and have a million friends. It’s hard for me, but some people are just able to do all this.”  With this mindset, many girls develop the mantra, “I just need to work harder,” driving a relentless, unsatisfying, and ultimately self-defeating quest for perfection.


Although parents often describe their daughters’ experiences in middle school and high school as worlds apart from those of their sons’, the extent of gender differences is rarely recognized. Boys are not immune to stress, but teen girls are far more prone to taking on intense pressures to succeed academically and socially. Girls also perceive that despite what boys may or may not accomplish during adolescence, males usually get higher paying and more prestigious jobs later on. How they process this information affects their views of themselves as well as their possibilities for the future. In general, these four factors distinguish teen girls from their male classmates:

View of school. Adolescent girls have a whole different way of looking at school, where they spend the majority of their weekday time and confront many of the hurdles to their success. Boys are typically unemotional about school; they see these years as a means to an end or a goal that simply needs to be achieved. Because they tend to look at the big picture rather than at the details that often preoccupy girls, they are not as reactive to the goings-on—or as inclined to take disappointments or setbacks personally.

For teen girls, however, school is all about the process. What happens throughout each and every school day – academically, socially, and emotionally – becomes a yardstick of their success. Every moment really matters.

Even relatively minor issues that accumulate throughout seven-hour school days
aggravate girls’ pressure. For example, one middle schooler recounted this classic, bad day scenario: “A bunch of little things happened that weren’t all that important, but it got under my skin. A stupid thing like the cafeteria lady yelled at me for putting my tray back in the wrong place and then I was late to P.E. because I forgot where I put my bag. My Spanish teacher was in a bad mood, I got a horrible grade on my English paper…” On and on, teen girls recall—and often discuss, obsess, and agonize about—the litany of dissatisfactions and frustrations that might never appear on the radar screens of their y-chromosomed classmates.

Importance of relationships. Peer group acceptance is crucial for most adolescents. But as described by Jean Baker Miller in Women’s Growth in Connection, girls’ self-worth develops primarily within the context of their relationships. Their sense of who they are is based in large part on how they impact other people. Teen girls feel most accomplished in school not only when they get good grades, but also when they are in sync with the people most important to them. Unless girls see their friendships and relationships with parents and teachers as strong and satisfying, they do not feel truly successful.

That is why teen girls keep a running mental inventory of the status of all their relationships. They review puzzling conversations, ponder compelling social exchanges, and imagine how others perceive their interactions. Continuously noting, evaluating, and reassessing the quality of these relationships gives girls a moment-to-moment reading on how others view them. Yet these efforts, which require tremendous mental and emotional energy, can further exhaust girls.

Of course, social ups and downs are inevitable. But listening to teen girls, it becomes clear that each up and each down during the course of every school day really counts. Each becomes a measure, however fleeting, of their self-worth.

For this reason, a teacher’s off-hand remark, a parent’s irritation, or a friend’s baffling expression are often more stressful for girls than adults would imagine. More than boys, girls feel like failures when they think they upset someone, can’t help a friend, or let down an adult. Accordingly, these everyday events affect girls differently and far more powerfully than they do boys.

Lucinda, a high school sophomore, came to me for therapy when she became increasingly depressed and lonely after being rebuffed by one of her oldest and closest friends. In our sessions, she speculated incessantly about what might have happened, what she possibly could have done to provoke her friend’s rejection, and how she might go about regaining her friend’s good opinion. Around that time, I was also seeing a teenage boy who told a similar story about a good friend who suddenly began to ignore him. “So what did you do?” I asked Tim. He looked at me quizzically for a moment. “I changed my lunch table,” he shrugged.

Ability to read people. Far more than boys, girls are socialized to interpret body language and other subtle nonverbal behavior. However, their skill at detecting nuances in other people’s attitudes and feelings also makes them more susceptible to infectious pressures for success. Girls quickly pick up on the apprehensions of others that swirl constantly around them—in class, on the ball field, at lunch and, especially, at the dinner table. Abbie, a high school student, says, “We have parents and teachers who almost always want you to be great in school, and they want you to also be great in anything you do after school. I’ve been taking Tae-Kwon-Do since I’m four; my parents want me to be as great as my brother.”

Like a match, parental nervous energy about achievement ignites and inflames girls’ own worries about whether they have what it takes to succeed.

Desire to please. Girls are generally more interested in pleasing adults. It is the rare teen girl who doesn’t, on some level, want to conform to what she believes her parents, teachers, and peers expect of her. So great is her desire for praise that she is often willing to take on lofty or seemingly unattainable goals. Just before she graduated from elementary school, for example, Kaylee wrote in an email: “My parents want me to be a computer. I feel so stressed, it’s like I have to get an A on everything. When I think about my career, I want to be a doctor for babies. I want to go to Yahl [sic] but I think I’m too dumb.”

As they mature, girls feel even more stressed when the expectations of their peers and adults conflict. It’s hard to satisfy everyone. For example, this is what Martina, a hard-working and determined teen, told me about the pressures in her largely Hispanic, urban high school:

Pressure comes from everyone—parents, teachers, media, friends, boyfriends, coaches. Teachers may want you to focus more in their class and get better grades. The media shows you stick thin models, violence, and sex. Parents want you to do well in everything, to be beautiful and healthy, athletic and smart. Friends demand your attention and pressure you to be just like them. Coaches push you hard, wanting you to work hard and lose weight. Your boyfriend may want you to grow your hair, dress more sexy, dress less sexy, or join a group.


This kind of virulent nervous energy is rampant among today’s teen girls. And yet, it is often hard to detect, even for the parents and educators who care most about them and their success. That is because teen girls are diligent about hiding their pain. They go to great lengths to deny or minimize their distress, leaving even attentive adults in the dark about their true feelings and experiences.

Even when there is irrefutable evidence that things are not going well, girls are pros at reassuring their parents (“I’m perfectly okay!”) or adopting an air of indifference to their mothers and fathers’ concerns (“My grade isn’t so bad; you should see what the rest of the class got!”). When they find themselves in hot water with their schoolwork, even girls who are typically forthright and reliable often make excuses (“It wasn’t my fault my teacher got mad!”) or lie (“Don’t worry, I caught up with my work!”).

These are some of the reasons why teen girls bury their anguish:

Fear of exposure. Self-consciousness, which peaks during the adolescent years, inhibits many girls from revealing their struggles. They are afraid of being even more scrutinized by adults who already monitor their ups and downs. Amy says, “My mother is constantly interrogating me about my friends. If I tell her anything bad that happened, it just makes it worse. Then she has to know everything!”

Need for autonomy. Teens are working hard to establish age-appropriate separateness from their parents. Thus, they avoid admitting to weaknesses that could result in dependency. “If I show my parents my poor grade on my math test,” says Tracy, “They’re going to take over my entire life. They’ll keep asking me if I studied, and then my Dad will insist on helping me every night and probably confuse me more.”

Fear of repercussions.  Almost without exception, girls are afraid of what their parents will do if they find out they are overwhelmed or struggling. Belinda says, “They’ll make me see a tutor and I won’t have any time to myself. And if I did really bad, they might say I can’t go online anymore or go out with my friends on weekends.”

Reluctance to raise parental anxiety.  Girls are keenly aware of the challenges in their parents’ lives, such as jobs, poor health, marital conflicts, divorce, and single parenthood. They also know that merely mentioning their struggles in some area or another can instantly provoke or inflame their parents’ worries. Skilled at empathizing, teens often fear “making things even worse.”

Avoidance of flaws.  In the midst of developing their own identities, girls’ self- confidence is already shaky. Unable to recognize that they are still evolving, they often see their deficiencies as permanent flaws—a view that is sometimes shared by adults. As Virginia put it, “Parents and society want you to be perfect. If you have one or two bad days, they think you’re just this really bad person.”

Comparisons to the ideal. Girls’ most obvious and available adult role models, their mothers, are middle-aged women who often have come to terms with themselves and their accomplishments. What teens don’t usually see are their mothers’ false steps, early mistakes, and insecurities, which women themselves have either forgotten or take for granted. Idealizing their mothers can inhibit girls from revealing their own struggles.

Stress is the norm. As they look around them and see their classmates hectically running around and complaining of all they have to do, girls believe these experiences must be normal. If they think their situation is no different from anyone else’s, they may feel less entitled to object or to ask for help when they need it.

With girls so determined to keep silent, it is tough for even the savviest of parents to find out what they are really going through. Getting teens to open up about anything is notoriously difficult; coaxing details about how well they are doing or how they are really feeling about their successes and failures can be next to impossible.

The fact that many parents feel isolated during their kids’ teenage years makes learning about their daughters’ lives even more frustrating. When they do get together with other parents, knowing that their teens zealously crave privacy makes mothers and fathers think twice before sharing anything personal. This makes it harder to get support. So while parents feel swept up in the flurry of escalating nervous energy around achievement, too often they remain unaware of the stress girls endure. Too often they are at a loss about how their own daughters are coping.

I have to admit that for a long while I too underestimated the prevalence and pervasiveness of girls’ hidden pressure. I thought that the hype about achievement was exclusive to the Northeast, perhaps to the New York metropolitan area, and surely to the more affluent, high-powered communities surrounding my own. Also, I believed that the girls who were brought for counseling were unusually vulnerable to stress. But I came to realize I was wrong on all counts. The truth is, the pressure to excel is a national phenomenon and its consequences are wreaking havoc on the lives of teenage girls everywhere.

An extraordinary number of teenage girls who never enter a mental health office are also feeling stressed, discouraged, and misunderstood in their efforts to be successful. Some are trying valiantly to keep up with superstar classmates or siblings.  Others would like to compensate for the failures of troubled brothers and sisters or to justify the sacrifices of hardworking parents. A few are living out their mothers’ or fathers’ own unfulfilled dreams. Nearly all want to live up to their parents’ expectations and make them proud.

Reluctant to reveal their pain, these ordinary girls are silent about their disappointments, ashamed of their inevitable mistakes, and nervous about their futures. Although many are going about their daily lives feeling sad and demoralized, if not despondent, they may act out their pain in a variety of ways not easily recognized as signs of distress. Their parents may not have the slightest idea how unhappy they are—
or why.

I discovered this somewhat by accident. In preparation for an article I was writing for Girls’ Life, the magazine posted a Question of the Week on their website asking readers about any pressures they were feeling to do well in school. This topic struck a chord. In response, I received hundreds of poignant emails from 9- to 15-year-
old girls from across the country.

For example, Colleen reported, “I came home crying today because there’s no time for me. I’m not even sure if my parents understand what it’s like. They never had such a tough time compared to us ’00 kids. I wouldn’t be surprised if we start dropping dead from anxiety attacks and heart problems before we hit 20.” Similarly, Anna wrote, “I definitely think that I am overwhelmed by schoolwork and the pressure that is put on me to get good grades by my peers, parents, and teachers. Sometimes I cry myself to sleep at night just thinking about a test. I honestly dread school every day. Every single day.”

As I read one compelling, disturbing email after another, it hit me that these young readers—who were so eager to pour out their hearts in the anonymity of cyberspace— seemed equally determined to keep their distress under wraps at home. Perhaps it was poring through this three- or four-inch stack of responses all at once that was so powerful. Or maybe it was seeing such distress spelled out in print. Regardless, I read these emails first in shock, then in horrified fascination, and finally with heartache and the idea for this book mingling in my head.


With nervous energy skyrocketing, this generation of girls needs the adults in their lives to do far more than in the past. Along with general understanding and support, they need voices of reason to counteract both the stress-inducing messages they get from this culture and the demoralizing, self-defeating beliefs some of them persist in telling themselves. But for this to happen, parents and teachers first must recognize the distress underlying teen girls’ attitudes and behavior.

Many signs of stress are so common that they are accepted as the normal, even expected cost of leading busy, productive lives. What teen, for example, hasn’t procrastinated in doing her homework, overreacted to a situation with a friend, or frozen while taking a test? What girl hasn’t lost her temper, been moody, excessively tired, or occasionally used aches or pains as an excuse to stay home from school? It is the rare daughter who hasn’t taken out her troubles on a younger sibling or stayed up until all hours and then been late for school the next morning.

Every parent and teacher should be aware of these basic truths about the insidious, sometimes devastating, effects of stress on girls throughout the school years:

Young girls are afflicted. The first thing adults need to know is this: Stress for success is no longer exclusive to ambitious high school seniors engaged in the nerve- racking college application process. The epidemic in this culture has spread to ever-younger girls, infecting those on the cusp of puberty as well as older adolescents. Too often I hear the voices of girls who already feel very tired and defeated, though they have yet to graduate from the relatively protected confines of elementary school.  Alex, for example, came to see me because her parents were puzzled by her sudden reticence about school and “meltdowns” at home when faced with nightly assignments. A petite ten-year-old with blond curls and enormous, widely set, ice blue eyes, her baby-face looks somehow seemed incongruous with her anguish: “The second I get home from school I start my homework and I work nonstop until dinnertime. I get headaches so much and I feel sick. And still, I have to go to middle school. And then I have to go to high school. And then I have to go to college.”

Middle school intensifies stress. By the time they enter the early teen years and middle school, developmental challenges exacerbate stress in every area. On the school front, girls are suddenly asked to follow mind-boggling rotating schedules, keep track of a slew of due dates, and deal with an array of teachers—each with their own preferences, idiosyncrasies, and expectations. This is the sort of juggling expected of corporate CEOs.

Adding to these new demands are the social challenges, which by middle school rival or surpass academic ones in both intensity and importance. In general, girls feel desperate to reconnect with friends they may now see less frequently during the school day. They need to reassure themselves of these old ties by helping each other with problems and analyzing the details of all their unsettling social interactions. Well before they get to high school, girls say they face daily dilemmas such as whether to get sleep or good grades; whether to work on math problems or friendship problems; and whether to study history or reflect on their own lives.

A generation ago, tweens who had yet to enter the halls of high school might have been playing Parchesi, dressing up their Barbie dolls, and jumping rope. Today, these young girls are obsessed with calculating their GPAs, managing their time, and getting into good colleges.

Pressures skyrocket during high school. When the stakes rise in high school, so does the level of stress—for girls as well as their families. That is because the road to success is increasingly lined with specific checkpoints against which achievement is measured—for example, whether or not teens get placed in honors or AP classes; their SAT scores; whether they are chosen for selective teams, music ensembles, or honors; if and by whom they were invited to proms, etc. Any one of these criteria can seem like the definitive word on whether or not girls are successful—or will be in the future. Jan expressed the pressures of many girls in high school when she told me:

The worst thing about eleventh grade is the pressure to get into a good school. My parents are pushing me to study harder. Plus, you get pressured by all your friends to spend time with them, to go to their party or hang out. Have this boyfriend; you need one. Or you get stressed about homecoming. It’s a big deal. Are you going? Who with? Do you have a dress? And with all this, I hope I get into a really good school and don’t die from the stress of applying.


Such issues may be common, even classic, during adolescence, but suffering from stress should not be accepted as a given. In fact, these are the harmful effects on girls’ physical health and mental well-being and, therefore, their ultimate success:

Sleep Deprivation. Perhaps the most blatant consequence is the widespread lack of sleep among teens today. Though they require eight to ten hours of sleep per night, adolescents generally get far less. Not surprisingly, when girls in middle school and high school are asked about their worst school experiences they typically speak of exhaustion:

“The stress, sleep deprivation, and depression that almost defined junior year” • “When the pressure comes on all in one week and I get very little sleep” • “Every time I have to work until 2AM or 3 in the morning and then sit through class the next day with a headache as time stops” • “Getting no sleep because of work, draining myself emotionally, physically, and mentally, and doing worse in school because of constant lack of sleep”

Girls are losing sleep for two main reasons. One, many are intentionally cheating themselves of sleep in order to do everything they need to do. As Tina describes, “I’m staying up later and later to finish homework, or maybe I just want to read something for fun, go online, or relax, but I still have to wake up just as early in the morning and start the whole cycle again.”

Two, girls are deprived of much-needed sleep because of insomnia; according to a 2004 Business Week cover story on sleep disorders, 40% of teens have trouble falling asleep or staying asleep. As girls often tell me, “My mind’s going a mile a minute,” “I’m too tired to fall asleep,” and “I have too much going on.” Regardless of whether they deliberately pull all-nighters to study or toss and turn for hours in their beds, the fallout of sleep deprivation is the same.

Susceptibility to Stress and Illness. Lack of sleep and the impairment in thinking ability that results deprive teen girls of much-needed skills to ward off the effects of stress. In addition, because of their compromised immune systems, they are more prone to illness. Getting sick and being absent from school cause additional stress because teens miss key class work or tests and fall behind their classmates.

Increased Craving for Stimulants. Exhaustion also affects blood chemistry, provoking unhealthy cravings for caffeine, chocolate, sugar, and junk food. (Many teen girls would be horrified to learn that chronic sleepiness is associated with weight gain, which causes more stress.) In one school I visited, a student-conducted survey found that the majority of girls drank up to three caffeinated beverages daily for extra energy.

Insufficient Exercise. Surveys also confirm a harmful decrease in physical activity among American females. A study conducted by the University of Michigan, for example, found that 9 to 12-year-old children are spending 60% less time playing outdoors. Tracking girls over a period of ten years starting at age 9 or 10, the National Heart, Lung, and Blood Institute reported an 83% decrease in median activity levels. Thus, by the time they are older teens, many engage in no regular exercise other than gym class.

Poorer Coping Abilities. With a distinct lack of down time, girls are less able to relax, sleep, read for pleasure, and exercise. This undermines their ability to combat both anxiety and depression. Similarly, without the benefit of solitary activities such as writing in journals, reading, and creating music or art, girls can’t soothe themselves as well. Teens today are caught in a classic Catch-22 bind: Too stressed-out to take good care of themselves, they are that much less capable of dealing with tremendous stress.

Diminished Brainpower. Chronic stress also more directly threatens girls’ success by eroding their brainpower. Without the restorative and memory-building benefits of a restful night’s sleep, girls can’t concentrate or think as well, and they learn more slowly. In fact, research shows that staying up throughout the night results in the same level of mental acuity as being intoxicated above the legal limit for driving in most states. It is no wonder that sleep-deprived people perform many kinds of tasks poorly.

Also, emotions powerfully affect cognition. In fact, this relationship is the focus of much scientific attention today. New methods of mapping brain activity are enabling neuroscientists to understand how feelings and cognition interact in the brain. For example, one group of researchers discovered that mild emotional states such as amusement and anxiety affect college students’ short-term memory. Neither emotional state nor the task alone made a difference; what mattered was the mood subjects were in while they did specific tests.

Plummeting Self-Esteem. Chronic stress breeds feelings of inadequacy, as well. Girls who find they can’t think clearly or perform well understandably lose confidence. Comparing themselves to the idealized role models that surround them in this culture, their schools, and even in their own families, many teens fear they will never measure up. They stop believing in themselves. They lose heart, not to mention motivation. Eventually, they stop trying.

Researchers confirm that less successful students self-handicap. That is, they sabotage their performance by procrastinating, studying for shorter periods of time, and barely reading their textbooks. This posture enables them to excuse their anticipated lack of excellence. If teens don’t give their all and do poorly, they can blame lack of effort instead of lack of competence. Girls would rather be seen as lazy than stupid.  This story is typical. A high school principal was asked to see a tenth grade girl whose teacher sent her out of class because of how she responded to a question. When the teacher asked her why she had gotten a D on a test, the girl had replied, “I wouldn’t waste my time studying this crap.” When the principal later spoke to her about this experience, she confessed, “I’d rather be bad than dumb.”

Thwarted Success. There is one symptom of stress that few parents or teachers can overlook: declining grades. This makes sense. The sheer number of hours girls spend in school, with all its simultaneous and complex social, emotional, and intellectual challenges, makes it likely that problems will show up there first. It is hard for parents and teachers to dismiss, rationalize, or justify a poor report card or test scores. They are most often seen—and correctly so—as red flags for trouble, perhaps even as girls’ unconscious requests for adults to sit up and take notice.

Less often, girls manage to hold it together, silently and cheerfully going about the business of meeting other people’s expectations. These teens don’t complain. In fact, they seem to do everything and to do it all easily. They are model students and perfect daughters, likely to elicit praise and gratitude from adults. In fact, they are often held up as examples for other girls to emulate. That is, until they reach a breaking point.


It is worth stating the obvious: Not a single girl gets through school unscathed. No teen is immune to experiencing problems. The crucial question for educators and parents, then, is to what degree girls are adversely affected or even incapacitated by stress. Given how well they hide their pain, how can we assume that when they seem to be doing okay they are really doing okay? How can we know when teens’ unhappiness with their activities, friends, or teachers, their struggle in a particular subject, or anxiety about their future is normal—and when we should be concerned? Which teens are at risk for full-blown crises?

Psychologists conducting research in the field of psychoneuroimmunology (PNI) may have some answers. According to a newly developed biopsychosocial model of health and well-being, unhealthy reactions to stress occur when life’s demands overtax coping skills. Whether stress results in a lowered immune response, susceptibility to infection, or depression depends on mitigating factors such as mental outlook, optimism, and social support. Perhaps most interesting, the body’s physiological responses to stress depend more on perceptions of inner resources than on actual coping ability. It is whether girls think they can manage—that is, self-confidence—that matters most.

This finding is consistent with clinical experience. Teens go into crisis when they believe their pressures are insurmountable. Whatever coping skills they have counted on in the past no longer seem to work for them. Some endure a traumatic event (e.g., a parental separation or death), others a relatively minor incident (e.g., a fight with friend or romantic breakup). But something tips the scales, or a bunch of little somethings converge at once: recovering from the flu, coming back to school after an extended absence, missing a social event, getting a bad grade, or ticking off a teacher. At some point, however, the teen in crisis reaches a critical threshold of what she can tolerate, exhausts her inner resources, and hits a wall.

As a psychologist who has been evaluating and treating adolescents since 1977, this I know for sure: More and more, my colleagues and I are seeing this kind of fallout from a myriad of stressors. A psychologist friend who has been on staff for 17 years at a large, regional high school recently told me, “By November of this year, we had more crises than during the entire school year last year.” She is not alone. Guidance counselors from across the country are reporting a sharp increase in psychological crises among students and, as a result, an overwhelming use of school resources.

National statistics confirm these anecdotal data. Serious mental health problems are not only increasing, but also occurring earlier in childhood. Psychological Jean Twenge of Case Western Reserve University found that normal children ages 9 to 17 are more anxious today than those treated for psychiatric disorders 50 years ago. A study conducted at Yale/New Haven Children’s Hospital found that within a four-year period in the mid-1990’s pediatric psychiatric emergency room visits rose 59%. Obsessive- compulsive disorders among youth are also skyrocketing.

Many stressed-out girls are turning to risk-taking behaviors such as using substances and engaging in inappropriate sexual activity. As one school administrator told me, “Girls who have to do well in school are very dutiful on the surface. They’re not going to violate the dress code, for example. But their interior lives are much more buried. They get into a lot of dreadful things. Girls can give you all the information about drugs and alcohol and sexual behaviors. But as soon as they get away from schools and parents, they just unload. Weekends are pretty wild around here.”

Although these teens are often thought of as troubled or rebellious, their behavior is actually best understood as attempts at self-medicating for anxiety and despair. This may explain a disturbing trend: for the first time ever, underage girls are using mind-numbing substances such as alcohol and tobacco at the same rate as boys.  Equally worrisome, these vulnerabilities to stress do not end with high school graduation. Ironically, with all the machinations of trying to get girls accepted into college, they are not doing as well once they get there.

The Higher Educational Research Institute at UCLA, for example, found that the emotional well-being of freshman hit an all-time low at the beginning of the 2001-2002 academic year, even before September 11, 2001. As an article on student wellness in the American Psychological Association’s Monitor on Psychology described, “At campuses all across the country, more undergraduate and graduate students are reporting depression, substance use, eating disorders, learning disabilities and, most commonly, problems adapting to college life.” Indeed, a 2004 study of 47,200 college students conducted by the American College Health Association found that 45% reported feeling so depressed during the past school year that it was difficult for them to function.

In response, a new federal law was enacted in October 2004 to provide grants to universities across the country to enhance mental health services on campuses. In addition to traditional therapies, colleges have begun to offer stressed-out students a variety of services—from massages to dog cuddling to biofeedback to stress-free zones.

But we have to do our part, as well. To send off teens to college well prepared, we have to encourage them to develop healthier attitudes about achievement and better strategies for coping with stress. Once again, girls need more help in these areas. The same UCLA study found that freshman coeds rated their sense of health and well-being lower than that of boys—and were twice as likely to report feeling frequently overwhelmed by everything they had to do.

By hiding their suffering, however, girls deprive themselves of potential understanding, reassurance, and support from adults. If they are not aware of their teen daughters’ inner lives and true experiences, how can even the most loving mothers and fathers know how to help them? Similarly, if teachers have no idea what is causing a girl to de-invest from school or sabotage her own success, how can they best intervene?


To find out what is really happening with today’s teens—why they are so stressed, who is most at-risk, and who is most resilient—I surveyed 2298 girls (691 in grades 6 through 8, and 1607 in grades 9 through 12) about their attitudes, pressures, and experiences with success. Students attended a variety of schools: public and private, coed and all-girls’, religious and secular, traditional and alternative. By posting this survey on the Girls’ Life web site, I also heard from girls across the country. A comparison group of 625 boys—98 in grades 6 through 8, and 527 in grades 9 through 12—also completed my questionnaire.

In addition to interviewing parents, teachers, and school administrators, I spoke with about 100 girls attending middle schools and high schools—either individually or in groups, on one occasion or over the course of a six-week period. Although many girls were Caucasian, I interviewed a number of first-generation Americans whose parents emigrated from South America, Africa, Asia, India, the Middle East, Puerto Rico, and the Dominican Republic. I spoke with girls from poor, working class, middle class, and affluent backgrounds; their parents’ highest level of education ranged from less than four years of high school to graduate school.

What I discovered is that all girls, even highly functioning ones, can be toppled into crises by a constellation of circumstances, temperament, personality style, past history, school dynamics, and community cultures. Furthermore, these at-risk girls form five distinct groups, each sharing specific vulnerabilities and preoccupations. Of course, teens often exhibit characteristics of more than one profile and have different sensitivities to stress over time. But these typologies of stressed-out girls offer parents and teachers a framework with which to identify and understand teens’ most common struggles, anticipate crises, and step in most effectively to avert them.

Girls who are perfectionistic, for example, are pressured by the consuming need to be exceptional. Because they fear making mistakes that could cost them their dreams or expose them as frauds, they avoid the risks that are often necessary for true discovery and accomplishment. Unless they feel sure of succeeding, they steer clear of challenges and stick instead to what seems safe or conventional. With this mindset, even mundane events such as getting disappointing grades, annoying their teachers, losing games, or fighting with their friends can seem cataclysmic.

Teens who experience personal or family problems make up another group of vulnerable girls whose pressing concerns prevent them from being able to invest fully in many areas of their lives. Strong emotions such as anger, anxiety, and despair—which they typically have trouble managing—sap their energy and prevent these girls from thinking sharply, flexibly, and creatively. Since the tragedies of 9/11, far more people are familiar with the devastating effects of perpetual tension and heightened vigilance on everyday concentration and productivity.

Teens in transition also need to adapt to a suddenly changed world. That is why girls who are starting middle school or high school or transferring to new schools are particularly vulnerable to the effects of stress—as are their families. Nervousness about the unknown, as well as the need to acclimate to different surroundings and demands, challenges everyone’s coping skills.

Another at-risk group is made up of insecure girls who long for peer acceptance. Their intense alertness to their classmates’ judgments siphons off crucial energy better directed toward creativity and achievement. Instead of thinking about lessons and ideas, they obsess about whether their outfits are acceptable, what someone’s behavior means, or if the comment they just blurted is really dumb. Insecure girls play it safe by fading into the background. They are loath to participate or speak up in class. In fact, they will do anything to avoid sparking debate, controversy, or possible derision.

Lastly, there are girls who feel undervalued at home or in school. Like square pegs in round holes, they don’t fit in. Sometimes their interests are unlike those of their classmates. Or they learn differently. When their talents don’t resemble those of their family’s, girls feel different (read: inferior). In addition to the typical stress for success, then, square pegs feel additional pressures to live up to the standards they perceive in their family or school cultures. If they’re not round pegs, they feel like failures.

What I also learned from my research is that all stressed-out girls, no matter their specific issues, are prone to becoming estranged from their inner lives. What I mean is that even teens who are driven to achieve are so busy living up to others’ expectations that they either don’t develop or eventually relinquish their own goals. They are so focused on achieving external emblems of success that they don’t get the chance to figure out what really excites them and gives them pleasure. They barely know who they are or who they want to become. More troubling, when accomplishments lose meaning, teens begin to feel bored and empty, states that I believe are related to the prevalence of serious problems such as depression, cutting, and eating disorders among young women today.

In contrast, I found that girls who have been given the chance to get to know themselves and to pursue their true interests are two steps ahead of the game. Teens who believe their parents and teachers have hopes for them that are realistic—and in line with their actual talents and passions—feel most equipped to succeed.   Equally important, I discovered that while affluence and having exceptionally accomplished parents can increase teens’ pressures and obligations, other factors protect them. What really matters is how resilient girls are to stress; this is determined by their self-confidence, social acceptance, validation, and coping skills.

This is why intellect and fine schooling do not guarantee success. In fact, the research is clear: Most successful people are not necessarily brilliant, but they are self- directed and passionate about what they do. A 20-year longitudinal study of learning disabled individuals by the Frostig Center in Pasadena, California, corroborates the importance of resiliency. Researchers identified six attributes associated with long-term life success: self-awareness, proactivity, perseverance, goal-setting, effective support systems, and emotional coping strategies.

What this means is that all the ambition in the world is not going to make up for a poor work ethic, lack of integrity, disorganization, or trouble getting along with others. Graduating from an elite college is not going to matter in the long run if a teen feels stressed-out, insecure, discouraged, defective, or resentful. Unless girls have their emotional and social houses in order, they can’t focus their energy and fully use their talents. Being smart is never enough.


While none of us can eliminate nervous energy, there is plenty we can do to help teen girls become stronger and more resilient. Demographics suggest there is no time to waste. With schools across the country scrambling to accommodate rising numbers of schoolage children, the already intense competition for private schools, internships, scholarships, jobs and, of course, colleges, is likely to climb further.

As a psychologist, I work with many families interested in learning how to capitalize on their daughters’ strengths, compensate for any weaknesses, and encourage the fullest expression of their talents. In my previous books—I’m Not Mad, I Just Hate You and Trust Me, Mom—Everyone Else is Going!—I guide parents to use empathy, respect, and mutual trust to develop close, empowering relationships with teen daughters. I also consult with educators, teachers and administrators on the needs of individual students as well as the developmental issues and challenges of girls in middle school and high school.

Fortunately, I have learned that parents and educators can have tremendous influence, more than would be imagined, but only with the right perspective and sensitivity. This book therefore begins by describing the context of teen girls’ stress, including the underlying cultural pressures and family dynamics that often contribute.

As the mother of two seniors, one in high school and one in college, I understand parents’ desires to see children succeed. I empathize with the worries, large and small. Especially as our girls progress through school and the educational stakes rise, we want to see that everything is going well so they keep the doors to their futures wide open. If earlier problems linger, we may fear that their bad habits have become entrenched or that their flaws will never improve. And we imagine that once our kids go to college, it will be too late to help them.

Also, I am all too aware of how our own past triumphs, disappointments, and failures can provoke strong convictions about what our daughters ought to be doing. We all want our girls to have every possible opportunity, especially those that were denied to us. We all want our girls to avoid the same mistakes we made. But it is crucial to differentiate our children’s interests and needs from our own and to keep a cool head in this atmosphere of escalating nervous energy. That is the only way to avoid blurring the boundaries and trying to live vicariously through our daughters.

The profiles in Part Two offer a framework with which to interpret what girls’ behavior probably means. Learning about other teens, you can better assess when your own daughter or student’s struggles are short-term, temporary developmental blips, and when girls could be spiraling into crises. This information will give you insight into what sorts of interventions typically work–and don’t work—within in each at-risk group. For example, when does a perfectionistic girl who chronically procrastinates need a nudge, and when does she need space or time? How can parents effectively help a struggling, brand-new middle school or high school student to adjust?

Whether you are supporting your daughter through a brief social rough patch, helping her overcome a sudden academic hurdle, or dealing with a full-blown crisis, Part Three gives you the practical tools. When is it wise to ask the school for help, and what is the best way to do so? What is reasonable to expect from teachers? If the school can’t provide the kind of expert help your daughter needs, what is your next step? And when is a mental health or educational consultation advisable?

Like so many parents, you too may be finding that even your best efforts aren’t helpful. To get a derailed daughter back on track, perhaps you resort to lecturing, cajoling, bribing, threatening, or punishing. Before long, stress permeates the household, provoking daily conflicts around what she ought to be doing—for example, whether her homework is done soon enough or well enough, if she has the right friends, and how long she can use the Internet or the phone.

In the process, however, girls often feel increasingly defensive, misunderstood, ashamed, and angry. That is because no matter how delicately we may raise concerns, they hear one of two unspoken accusations: either that they are not trying their best, or that their best isn’t good enough. Teens feel criticized, judged, or pushed to be someone they’re not. In a flash, it seems, girls view us as adversaries rather than allies.

This book offers a fresh perspective. An inside look into teen girls’ hidden stress will give you vital information that will help you to keep your own anxiety under control. The insights you gain about your own daughter will enable you to bolster her resiliency. As you learn what your next step should be, you will take it with confidence. Above all, you will be better equipped to stay close to your teen and maintain the sort of relationship that fosters her success.





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